Leading and following: an exploration of the factors that facilitate or inhibit effective leadership in critical care settings in Bahrain

Abstract

The intention of this case study research is to explore the factors that facilitate or inhibit effective leadership in Critical Care Settings (CCSs) in a government hospital in Bahrain. The study focuses on Head Nurses (HNs) working in the CCSs, since those positions play a pivotal role in creating and maintaining a Healthy Working Environment (HWE) for nursing practice. In this research the abbreviation ‘Head Nurse (HN)’ will be used and it stands for Charge Nurse/ Ward Sister/ Nurse Supervisor.

According to Ministry of Health (MoH) policies, the leadership in Bahrain encounters a variety of challenges including: demands for efficiency, cost cutting and a value for money service; finding alternative ways of funding; ensuring appropriate human resources; supporting improved management practices; developing a proper structure; higher customer expectations; and knowledge armed customers.

A qualitative case study design was used. This approach allows the study to explore the important factors that facilitate or hinder leadership effectiveness such as the individual professional factors (e.g. leadership style, communication, the relationship, and the educational factors) and the organizational factors which include for example healthy working environment and the organizational structure.

Data were gathered through in-depth semi-structured interviews with key informants (KIs), HNs and Senior Staff Nurses (SSN), as well as through observing HNs in clinical practice and document analysis (e.g. minutes of meetings and department annual reports). The emerging qualitative data have been analysed through coding and grouping according to themes.

The findings revealed that effective HN leaders were recruited, and designated to the posts without development plans or without formal presentation. There was a lack of effective HN leaders who have the capabilities that are considered crucial in such a role (e.g. characteristics of emotional intelligence and authenticity). The study findings generated generic issues surrounding leadership in healthcare settings which resonate with the literature. The participants in this study talked about the characteristics of effective leaders in general rather than specifically emphasizing on issues like being in the frontline during a crisis to make quick decision that are required in critical situations.

Key messages from the research indicate that effective head nurse leaders play a pivotal role in establishing and sustaining a healthy working environment. Also head nurses working in critical care settings should exhibit specific characteristics such as being: empathetic, open and honest, optimistic, visionary, accessible to be effective leaders.

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